Multivariate analyses of mortality from coronary heart disease due to biological and behavioural factors

Abstract

Due to affluence and a sedentary life style a great deal of people in the western countries are affected by coronary heart disease (CHD). The relation between CHD and certain risk factors pertaining to life style is evaluated in this study. A primary purpose is to study certain crucial risk factors for women. The main variables are age, smoking, overweight (measured by BMI), blood pressure and exercise.

This prospective study is based on self-reported data from the nation-wide Swedish Level of Living Survey and on data from the national Cause of Death Register. The data were analysed separately by sex using a proportional hazards model. The sample was divided into two strata: those with heart disease and/or diabetes initially, and all the rest.

A sample of 2546 men and 2760 women between 45 and 74 years of age was followed from 1980 to the end of 1990. During this period 189 men and 75 women died of coronary heart disease (CHD).

It was found that high blood pressure raised the relative risk (RR) of death from CHD by almost 60% in both men and women. Male smokers (< 14 cigarettes a day) had about 60% (significant) and female smokers (< 10 cigarettes a day) 150% (significant) excessive mortality from CHD. Different levels of overweight among women were strongly related to excess mortality from CHD, ranging between 100 and 300%. Among men there was no such relation. Lack of physical activity showed only a weak (non-significant) increased risk of death due to CHD. Diabetes was also found to be an important risk factor for mortality from CHD, especially among women, being seven times as high as among non diabetics. A test of sex differences revealed that there were two significant interactions, namely between sex and overweight, and between sex and age. Background variables in relation to mortality from all cardiovascular diseases (CVD) were also studied. There were of course many similarities between the effects of the background variables in both the disease groups, but there were interesting differences too, e.g. overweight turned out to be a significant risk factor also for men and physical inactivity for women.

Keywords

CHD smoking overweight exercise high blood pressure diabetes

Get full access to this article

View all access options for this article.

References

Hansson L. The key issues in preventive cardiology . Blood Press 1992; 1, Suppl 4: 7–10.

Haynes S , Feinleib M , Kannel WB. The relationship of psychosocial factors to coronary heart disease in the Framingham study III. Eight-year incidence of coronary heart disease . Am J Epidemiol 1980; 111: 37–58.

Theorell T , Floderus-Myrhed B. “Workload” and risk of myocardial infarction - A prospective psychosocial analysis . Int J Epidemiol 1977; 6: 17–21.

Johnson J. The impact of workplace social support, job demands and work control upon cardiovascular disease in Sweden. Department of Psychology, University of Stockholm, Stockholm, 1986.

Johnson J , Hall EM. Job strain, work place, social support and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population . Am J Publ Health 1988; 78: 1336–42.

Rosén M , Wall S , Hanning M , Lindberg G , Nyström L. Smoking habits among different occupational groups in Sweden . Scand J Soc Med 1987; 15: 233–40.

Östlin P. Negative health selection into physically light occupations . J Epidemiol Community Health 1988; 42: 152–6.

Östlin P , Thorslund M. Problems with cross-sectional data in research on working environment and health . Scand J Soc Med 1988; 16: 139–43.

Lapidus L , Bengtsson C , Lindquist O , Sigurdsson JA , Rafnsson V.

Smoking - a risk factor for cardiovascular disease in women?

Scand J Prim Health Care 1986; 4: 219–24.

10.

Stokes III J , Kannel WB , Wolf PA , Cupples LA , D'Agostino RB. The relative importance of selected risk factors for various manifestations of cardiovascular disease among men and women from 35 to 64 years old: 30 years of follow-up in the Framingham study . Circulation 1987; 75, suppl V: V-65–73.

11.

Carlson L , Böttiger LE. Risk factors for ischemic heart disease in men and women. Results of the 19-year follow-up of the Stockholm Prospective Study . Acta Med Scand 1985; 218: 207–11.

12.

Julius S , Hansson L , Andre'n L , Gudbrandsson T , Sivertsson R , Svensson A. Borderline hypertension . Acta. Med Scand 1980; 208: 481–9.

13.

Lind L , Lithell H. Hypertension, hyperlipidemia, insulin resistance and obesity: Parts of a metabolic syndrome . Blood Press 1992; 1, Suppl 4: 49–54.

14.

Lapidus L , Bengtsson C , Larsson B , Pennert K , Rybo E , Sjöström L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden . Br Med J 1984; 289: 1257–61.

15.

Ford E , DeStefano F. Risk factors for mortality from all causes and from coronary heart disease among persons with diabetes . Am J Epidemiol 1991; 133: 1220–30.

16.

Garcia M , McNamara PM , Gordon T , Kannel WB. Morbidity and mortality in diabetics in the Framingham population: Sixteen year follow-up study . Diabetes 1974; 23: 105–11.

17.

Reaven G. Role of insulin resistance in human disease . Diabetes 1988; 37: 1595–1607.

18.

Technical report from the 1980-81 Swedish Annual Level of Living Survey (in Swedish). Appendix 6. 1983. National Central Bureau of Statistics; Sweden.

19.

Swedish Cause-of-Death register 1980-1990. National Central Bureau of Statistics; Sweden.

20.

Report of a joint FAO/WHO/UNU expert consultation. Technical Report Series No. 724. Geneva: WHO 1985.

21.

Janlert U , Nyström Peck M. A comparison between self-reported health and a medical examination concerning coronary heart diseases in northern Sweden (to be published).

22.

SAS Institute Inc. , SAS Technical Report P-217, SAS/STAT software: The PHREG, Version 6, Cary, NC: SAS Institute Inc., 1991.

23.

Manson J , Colditz GA , Stampfer MJ , Willett WC , Rosner B , Monson RR et al. A prospective study of obesity and risk of coronary heart disease in women . N Engl J Med 1990; 322: 882–9.

24.

Levy D. Left ventricular hypertrophy. Epidemiological insights from the Framingham Heart Study . Drugs 1988; 35, Suppl 5: 1–5.

25.

Lapidus L , Bengtsson C , Lindquist O , Sigurdsson JA , Rybo E.

Triglycerides - main lipid risk factor for cardiovascular disease in women?

Acta Med Scand 1985; 217: 481–9.

26.

Walldius G , Jungner I , Kolar W , Holme I , Steiner E. High cholesterol and triglyceride values in Swedish males and females: Increased risk of fatal myocardial infarction. First report from the AMORIS (Apolipoprotein related Mortality RISk) study . Blood Press 1992; 1, Suppl 4: 35–42.

27.

Castelli W. The triglyceride issue: A view from Framingham . Am Heart J 1986; 112: 432–7.

28.

Hulley S , Rosenman RH , Bawol RD , Brand RJ. Epidemiology as a guide to clinical decisions. The association between triglyceride and coronary heart disease . N Engl J Med 1980; 302: 1383–9.

29.

Wilhelmsen L , Wedel H , Tibblin G. Multivariate analysis of risk factors for coronary heart disease . Circulation 1973; 48: 950–8.

30.

Kannel W , McGee DL. Diabetes and cardiovascular risk factors: The Framingham study . Circulation 1979; 59: 8–13.

31.

Barrett-Connor E , Wingard DL. Sex differential in ischemic heart disease mortality in diabetics: A prospective population-based study . Am J Epidemiol 1983; 118:489–96.

32.

Salonen J , Puska P , Tuomilehto J. Physical activity and risk of myocardial infarction, cerebral stroke and death. A longitudinal study in eastern Finland . Am J Epidemiol 1982; 115: 526–37.

33.

Powell K , Thompson PD , Caspersen CJ , Kendrick JS. Physical activity and the incidence of coronary heart disease . Ann Rev Public Health 1987; 8: 253–87.